Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era
- 223 Downloads
Laparoscopic cholecystectomy is the most commonly performed laparoscopic procedure. It is superior in nearly every regard compared to open cholecystectomies. The one significant aspect where the laparoscopic approach is inferior regards the association with bile duct injuries (BDI). The BDI rate with laparoscopic cholecystectomy is approximately 0.5%; nearly triple the rate compared to the open approach. We propose that 0.5% BDI rate with the laparoscopic approach is no longer accurate.
The National Surgical Quality Improvement Program (NSQIP) registry was retrospectively reviewed. All laparoscopic cholecystectomies performed between 2012 and 2016 were extracted. A total of 217,774 cases meeting inclusion criteria were analyzed. The primary data points were the overall BDI incidence rate and time of diagnosis. BDI were identified by ICD-9 and ICD-10 codes. Secondary data points were variables associated with BDI.
The BDI rate was 0.19%. 77% of cases were diagnosed after the index surgical admission. Intra-operative cholangiography (IOC) use was associated with a higher BDI rate and higher identification rate of a BDI intraoperatively (P value < 0.0001). Resident teaching cases were protective with a RR score of 0.56 (P value < 0.0001). The presence of cholecystitis increased the risk of a BDI with a RR score of 1.20 (P value < 0.0001). There was a low conversion rate of 0.04% however converted cases had a nearly hundredfold increase in BDI at 15% (P value < 0.0001).
The performance of laparoscopic cholecystectomies in North America is no longer associated with higher BDI rates compared to open. IOC use still is not protective against BDI, and cholecystitis continues to be a risk factor for BDI. When a cholecystectomy requires conversion from a laparoscopic to an open approach the BDI increases a hundredfold; which may raise the concern if this approach is still a safe bailout method for a difficult laparoscopic dissection.
KeywordsBile duct injury BDI Laparoscopic cholecystectomy Procedural safety
Compliance with ethical standards
Drs. Christopher W. Mangieri, Bryan P. Hendren, Matthew A. Strode, Bradley C. Bandera, and Byron J. Faler have no conflicts of interest or financial ties to disclose.
- 2.Fingar KR (2006) Most frequent operating room procedures performed in U.S. hospitals, 2003–2012 #186. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb186-Operating-Room-Procedures-United-States-2012.jsp. Accessed 12 May 2017
- 4.Perugini RA, Callery MP (2001) Complications of laparoscopic surgery. In: Holzheimer RG, Mannick JA (eds) Surgical treatment: evidence-based and problem-oriented. Zuckschwerdt, MunichGoogle Scholar
- 13.ACS National Surgical Quality Improvement Program (n.d.) American College of Surgeons. Web. 14 Nov 2017Google Scholar
- 15.Verhovshek J (2015) Laparoscopic-to-open surgery coding. AAPC—Advancing the business of healthcare, AAPC Blog. http://www.aapc.com/blog/27975-laparoscopic-to-open-surgery-coding/. Retrieved 16 Jan 2015
- 20.Cameron JL, Cameron AM (2017) Chapter 84: Management of benign biliary strictures. In: Current surgical therapy, 12th edn. Elsevier, Amsterdam, pp 445–451Google Scholar
- 21.Townsend CM et al (2016) Chapter 54: Biliary system. In: Sabiston textbook of surgery: the biological basis of modern surgical practice, 20th edn. Elsevier Saunders, Philadelphia, pp 1482–1519Google Scholar